Surgical speed and risk for maternal operative morbidity in emergent repeat cesarean delivery

• DOI: 10.1016/j.ajog.2015.06.055
• Publication Date: 2015-07-04T23:26:31Z
• Authors: Leslie Moroz; Marianne DiNapoli; Mary D’Alton; Cynthia Gyamfi-Ba...
• Keywords: Adult; Hematoma; Time Factors; Broad Ligament; Operative Time; Postpartum Hemorrhage; Blood Loss, Surgical; Trial of Labor; 3. Good health; Uterine Artery; 03 medical and health sciences; 0302 clinical medicine; Pregnancy; Adnexal Diseases; Multivariate Analysis; Humans; Regression Analysis; Blood Transfusion; Female; Cesarean Section, Repeat; Prospective Studies; Emergencies; Ligation

The purpose of this study was to determine whether surgical speed is associated with maternal outcomes in women who have a history of previous cesarean delivery (CD) and who require emergent delivery.This is a secondary analysis of a multicenter, prospective observational study of women with a history of previous CD. Women who attempted a vaginal birth after CD and required emergent CD were dichotomized into those with a skin incision-to-fetal delivery time of ≤2 min (I-D ≤2) or >2 min (I-D >2), based on the mode I-D. Rates of composite maternal complications and specific surgical complications were compared.Seven hundred ninety-three women had an emergency repeat CD: 108 women (13.6%) had I-D ≤2, and 685 women (86.4%) had I-D >2. The composite of maternal morbidity occurred in 36% of women with I-D≤2 and 23% with I-D>2 (P < .01). Women with I-D ≤2 had higher odds of intraoperative transfusion, uterine artery ligation, and broad ligament hematoma. In a multivariable regression model, the only variable that remained associated with maternal outcome was I-D (relative risk, 1.66; 95% confidence interval, 1.23-2.23). There was no difference in the incidence of neonatal acidemia between groups.Among women who underwent emergent repeat cesarean delivery, surgical speed was associated with an increased risk for maternal complications.